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Impact of Growth Hormone Receptor Blockade on Substrate Metabolism during Fasting in Healthy Subjects

Medical Department M (Endocrinology and Diabetes) and the Medical Research Laboratories (L.M., N.J., A.F., N.M., J.O.L.J.), Clinical Institute, Aarhus University Hospital, Aarhus Sygehus, DK-8000 Aarhus C, Denmark; Department of Internal Medicine (H.N.), Viborg Hospital, DK-8800 Viborg, Denmark; Department of Endocrinology and Metabolism C (S.B.P.), Aarhus University Hospital, Aarhus Sygehus, THG, DK-8000 Aarhus C, Denmark; and Department of Medicine (B.D.G., J.L., M.O.T.), University of Virginia Health System, Charlottesville, Virginia 22903

Address all correspondence and requests for reprints to: Louise Moller, Medical Department M (Endocrinology and Diabetes), Aarhus Sygehus, Norrebrogade 44, DK-8000 Aarhus, Denmark. E-mail: louisem{at}dadlnet.dk.

Context: Experimental studies in GH-deficient patients and in healthy subjects receiving somatostatin-infusion suggest that GH is an important regulator of substrate metabolism during fasting. These models may not adequately reflect the selective effects of GH, and GH receptor (GHR) blockade offers a new model to define the metabolic role of GH.

Objective: The aim of this study was to investigate the impact of GHR blockade on substrate metabolism and insulin sensitivity during fasting.

Design: We conducted a randomized, placebo-controlled, crossover study in 10 healthy young men.

Intervention: After 36 h of fasting with saline or pegvisomant (GHR blockade), the subjects were studied during a 4-h basal period and 2.5-h hyperinsulinemic euglycemic clamp.

Main Outcome: We measured whole-body and forearm glucose, lipid, and protein metabolism, peripheral insulin sensitivity, and acyl and desacyl ghrelin.

Results: GHR blockade significantly suppressed circulating free fatty acids (1226 ± 83 vs. 1074 ± 65 µmol/liter; P = 0.03) and ketone bodies (3080 ± 271 vs. 2015 ± 235 µmol/liter; P 0.01), as well as forearm uptake of free fatty acids (0.341 ± 0.150 vs. 0.004 ± 0.119 µmol/100 ml · min; P < 0.01) and lipid oxidation (1.3 ± 0.1 vs. 1.2 ± 0.1 mg/kg · min; P = 0.03) in the basal period. By contrast, IGF-I levels in either serum or peripheral tissues were not impacted by GHR blockade, and protein metabolism was also unaffected. Basal glucose levels were elevated by GHR blockade, but insulin sensitivity was similar; this was associated with an increased acyl/desacyl ghrelin ratio.

Conclusion: GHR blockade, without changes in circulating or tissue IGF-I levels, selectively suppresses lipid mobilization and oxidation after short-term fasting. This supports the notion that stimulation of lipolysis is a primary and important effect of GH.